Pulse Oximetry Testing in Primary Teeth Seems to be as Accurate as Electric Pulp Testing

Clinical Question

In primary teeth of unknown pulpal status, is pulse oximetry a more accurate indicator of pulp vitality as compared to electric pulp testing (EPT) when testing pulp vitality?

Clinical Bottom Line

Pulse oximetry seems to be at least as accurate as electric pulp testing when testing pulp vitality in primary teeth. This is supported by a controlled diagnostic study comparing the two methods of pulp testing as well as other studies that confirm the ability of pulse oximetry to detect pulpal blood flow.

Overall, pulse oximetry was shown to be about as accurate as electric pulp testing (EPT) in testing pulp vitality in primary teeth. In the control group, the sensitivity and specificity measured using EPT was 0.9, whereas for pulse oximetry it was 1.0. The difference was not statistically significant (p-value = .487). Pulse oximetry and EPT produced similar sensitivity (both 1.0) and specificity (pulse oximetry: 1.0 ; EPT: .9) values when used on primary second molars. The p-value was 1.0. In children requiring endo, there was a bigger difference in both sensitivity (pulse oximetry: 0.98; EPT: 0.85) and especially in specificity (pulse oximetry: 1.0; EPT: 0.44). The difference was statistically significant (p-value = .003)

The control group (non-vital teeth) all recorded SaO2 (oxygen saturation) values of 0%. The average SaO2 value recorded on primary incisors was 93% (sd = 3.23). Doing a Spearman correlation analysis between the SaO2 values for the primary incisors and the SaO2 values on the index finger gave a correlation of 0.22.

All 4 teeth that had filled roots recorded SaO2 (oxygen saturation) values of 0%. In immature teeth with a closed apex, the mean SaO2 was 83.14% for the maxillary left lateral (sd= 1.432), 84.61% for the maxillary left central (sd = 2.170), 85.00% for the maxillary right central (sd= 2.062), and 81.82% for the maxillary right lateral tooth (sd= 1.565). The results were similar when measuring mean SaO2 in teeth with an open apex. The mean SaO2 was 84.50% for the maxillary left lateral (sd= 1.518), 86.71% for the maxillary left central (sd = 2.052), 86.83% for the maxillary right central (sd= 2.293), and 83.35% for the maxillary right lateral tooth (sd= 1.578).

Evidence Search

"Oximetry"[Mesh] AND "Dental Pulp Test"[Mesh]

Comments on
The Evidence

Validity: All three studies properly defined their sample group. All three studies only accepted teeth that were free from caries, trauma, mobility, and pathology. One issue is that in none of these studies were either the participants or investigators blinded. All three used a control group (endodontically-treated teeth) to which to compare their findings. The groups in each case were treated the same, each undergoing either EPT or pulse oximetry testing depending on the study. No conflicts of interest were mentioned, nor were there any found.
Perspective: One weakness of the studies was that they were not longitudinal. A longitudinal study testing the same tooth over time would have added another dimension and provided a better gauge of accuracy for pulse oximetry and EPT. One issue with the third study (Bargrizan 2015) is that the teeth analyzed were immature permanent teeth, not primary teeth. Therefore, this study is not fully relevant to the PICO question. More studies are definitely needed to better answer this PICO question. A big reason for a lack of literature over this topic is that pulse oximetry testing for pulp was introduced only fairly recently. A systematic review or meta-analysis would strengthen the answer to this PICO question greatly. The conclusions reached in this study do seem to agree with the current thinking about pulse oximetry, that while it seems to be a good non-traumatic alternative to EPT in children, more research is still needed to confirm this.

Applicability

Pulp testing is an extremely common procedure in the office of a general dentist. The evidence from these studies shows that pulse oximetry is an equally effective way to determine pulp vitality in primary teeth. Regardless, all three studies proved that pulse oximetry is a good alternative to EPT and more importantly is atraumatic and noninvasive, which is a big benefit for pediatric dentists and dentists who work with kids, especially kids who suffer from dental anxiety.

Specialty/Discipline

(Endodontics) (General Dentistry)

Keywords

Electric pulp tester (EPT); Pulse oximeter; Vitality

ID#

3034

Date of submission:

03/12/2016

E-mail

SETHIS@livemail.uthscsa.edu

Author

Shravik Sethi

Co-author(s)

Co-author(s) e-mail

Faculty mentor/Co-author

Kelly C. Lemke, DDS

Faculty mentor/Co-author e-mail

LemkeK@uthscsa.edu

Basic Science Rationale(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)

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